What is Calcium Imbalance ?
Calcium plays an indispensable role in cell permeability, the formation of bones and teeth, blood coagulation, transmission of nerve impulses, and normal muscle contraction. Nearly all of the body's calcium is in the bones. The remaining exists in serum in three forms: ionized or free calcium (the only active, or available, calcium), calcium bound to protein, and calcium complexed with citrate or other organic ions.The maintenance of ionized calcium in the serum is critical to healthy neurologic function. The parathyroid glands regulate ionized calcium and determine its resorption into bone, absorption from the GI mucosa, and excretion in urine and stools.
Causes of Calcium Imbalance
Hypocalcemia may result from:
Hypercalcemia may result from:
Signs & Symptoms of Calcium Imbalance
If you have too little calcium, you may experience:
Total serum calcium levels are less than 8.5 mg/dl in hypocalcemia; greater than 10.5 mg/dl in hypercalcemia.
Ionized serum calcium levels less than 4.5 mg/dl confirm hypocalcemia; levels greater than 5.3 mg/dl confirm hypercalcemia. (Because about one-half of serum calcium is bound to albumin, changes in serum protein levels must be considered when interpreting serum calcium levels.)
Sulkowitch's urine test shows increased calcium precipitation in hypercalcemia.Electrocardiogram (ECG) results are significant for lengthened QT interval, prolonged ST segment, and arrhythmias in hypocalcemia. In hypercalcemia, a shortened QT interval is seen. Ventricular arrhythmias may occur with severe hypercalcemia.
The aim of treatment is to correct acute imbalance, followed by maintenance therapy and correction of the underlying cause.
A patient with mild hypocalcemia may require only a diet adjustment to allow adequate intake of calcium, vitamin D, and protein, possibly with oral calcium supplements.
Acute hypocalcemia is an emergency that needs immediate correction by I.V. administration of calcium gluconate, which is usually preferable to calcium chloride. If hypocalcemia is related to hypomagnesemia, magnesium replacement is necessary because hypocalcemia often doesn't respond to calcium therapy alone.
Patients with chronic hypocalcemia also require vitamin D supplements to facilitate GI calcium absorption. To correct mild deficiency, the amount of vitamin D in most multivitamin preparations is adequate. For severe deficiency, vitamin D is used in four forms: ergocalciferol (vitamin D2), cholecalciferol (vitamin D3), calcitriol, and dihydrotachysterol, a synthetic form of vitamin D2.
Treatment for patients with hypercalcemia that produces no symptoms may consist only of managing the underlying cause. Treatment of hypercalcemia that produces symptoms primarily eliminates excess serum calcium through hydration with normal saline solution, which promotes calcium excretion in urine. Loop diuretics, such as ethacrynic acid and furosemide, also promote calcium excretion. (Thiazide diuretics are contraindicated in hypercalcemia because they inhibit calcium excretion.)
Corticosteroids, such as prednisone and hydrocortisone, are helpful in treating sarcoidosis, hypervitaminosis D, and certain tumors. Mithramycin can also lower serum calcium levels and is especially effective against hypercalcemia secondary to certain tumors. Calcitonin may also be helpful in certain instances. The administration of I.V. phosphates is potentially dangerous and is used only when other treatments prove ineffective.
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